影响拇趾外翻患者矫正手术效果的因素分析

Analysis of Factors Influencing the Efficacy of Corrective Surgery in Patients with Hallux Valgus

目的:探讨影响拇趾外翻患者矫正手术效果的因素,为临床手术治疗提供参考。方法:回顾性收集2017年11月至2022年11月收治的因拇趾外翻行矫正手术治疗的186例患者临床资料,术前、术后末次随访均采用曼彻斯特-牛津足部问卷(MOXFQ)评估手术效果,根据术后末次随访和术前MOXFQ评分的差值将患者分为改善组和无改善组。收集相关临床资料,采用多因素Logistic回归分析影响拇趾外翻患者矫正手术效果的因素。结果:术后38例患者畸形无改善,148例患者畸形改善。无改善组年龄大于改善组,差异有统计学意义(P<0.05);女性、糖尿病、吸烟史、周围血管疾病、美国麻醉医师协会(ASA)分级>1级、重度畸形、术后拇趾外翻复发和转移性跖骨痛比例高于改善组,差异有统计学意义(P<0.05);微创术式比例低于改善组,差异有统计学意义(P<0.05);术后末次随访美国足踝关节协会(AOFAS)评分及Maryland足部评分低于改善组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示术后拇趾外翻复发、转移性跖骨痛、糖尿病、术前重度畸形是拇趾外翻患者矫正手术无改善的危险因素,差异有统计学意义(P<0.05);微创术式是保护因素,差异有统计学意义(P<0.05)。结论:术后拇趾外翻复发、转移性跖骨痛、糖尿病、术前重度畸形与拇趾外翻患者矫正手术效果较差有关,微创术式可改善手术效果。

Objective:To explore the factors affecting the efficacy of corrective surgery in patients with hallux valgus,and to provide reference for clinical surgical treatment.Methods:186 patients who received corrective surgery for bunion valgus from November 2017 to November 2022 were retrospectively collected.The results of surgery were evaluated by Mancunian-Oxford foot questionnaire(MOXFQ)before and after the last follow-up.Patients were divided into improved group and non-improved group according to the difference of MOXFQ score between last postoperative follow-up and preoperative.The related clinical data were collected and the factors influencing the efficacy of corrective surgery for patients with hallux valgus were analyzed by multivariate logistic regression.Results:There was no improvement in 38 patients and improvement in 148 patients.The age of the no-improvement group was higher than that of the improvement group(P<0.05),the proportions of female,diabetes,smoking history,peripheral vascular disease,American society of aneshesiologists(ASA)grade>1,severe deformity,postoperative recurrence of bunion and metastatic metatarsal algia were higher than those of the improvement group(P<0.05),and the proportions of minimally invasive surgery were lower than those of the improvement group(P<0.05).The American orthopedic foot and ankle society(AOFAS)score and Maryland foot score in the last postoperative follow-up were lower than those in the improved group(P<0.05).Multivariate logistic regression analysis showed that postoperative recurrence of bunion valgus,metastatic metatarsal algia,diabetes and preoperative severe deformity were risk factors for no improvement in bunion valgus patients(P<0.05),and minimally invasive surgery was protective factor(P<0.05).Conclusion:Postoperative recurrence of bunion valgus,metastatic metatarsal algia,diabetes mellitus,and severe deformity before surgery are associated with poor surgical results in bunion valgus patients.Minimally invasive surgery can improve surgical results.